Functional neurology after the Second World War: The beginnings of neurology on screen (III).

Treatment of functional symptoms has a long history, and interventions were often used in soldiers returning from battle. On the 75th anniversary of the end of the Second World War, I review the portrayal of neurology in documentary film. Two documentaries were released in 1946 and 1948 (Let There Be Light and Shades of Gray, respectively), which showed a number of soldiers with functional neurology including paralysis, stuttering, muteness, and amnesia. The films showed successful treatments with hypnosis and sodium amytal by psychoanalytic psychiatrists. These documentaries link neurology with psychiatry and are remarkable examples of functional neurology and its treatment on screen.

The therapeutic discharge: An approach to dealing with deceptive patients.

OBJECTIVE: Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these patients and keep further harm, iatrogenic or otherwise, from being inflicted. METHOD: Once an indication has been identified, the therapeutic discharge can be carried out in a stepwise fashion, resulting in a safe discharge. We outlined how to prepare for, and execute, the therapeutic discharge, along with preemptive consideration of complications that may arise. RESULTS: Consequences for the patient, physicians, and larger healthcare system are considered. CONCLUSION: The therapeutic discharge is a safe and effective procedure for patients with deception syndromes in acute care settings. Carrying it out is a necessary element of psychiatric residency and psychosomatic medicine fellowship training.

Does the disorder matter? Investigating a moderating effect on coached noncredible overreporting using the MMPI-2 and PAI.

The use of psychological tests to help identify the noncredible overreporting of psychiatric disorders is a long-standing practice that has received considerable attention from researchers. The purpose of this study was to experimentally determine whether feigning specific psychiatric disorders moderated the influence of coaching on the detection of noncredible overreporting using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI). Using a 2 × 3 experimental analogue design, 265 undergraduates were asked to feign schizophrenia, posttraumatic stress disorder, or generalized anxiety disorder and were either coached about validity scales and disorders or not. The results of this study indicated that the specific psychiatric disorder being feigned did moderate the impact coaching had on the detection of overreported psychopathology using several scales on the MMPI-2 and PAI. Future research examining noncredible overreporting should take into account the impact caused by the interaction of psychiatric disorder with coaching on the detection of symptom overreporting and also identify other important moderating/mediating variables in order to develop more effective means of identifying response bias.

The A-Test: a symptom validity indicator embedded within a mental status examination for Social Security Disability.

During the Psychological Consultative Examination (PCE) for Social Security Disability evaluations, there is a need for symptom validity measures to validate the findings for claims of disability (Chafetz, 2010 ). The "A" Random Letter Test of Auditory Vigilance (A-Test) is a simple auditory continuous performance test utilized as part of a comprehensive mental status examination (Strub & Black, 1993 ). The present study validates the use of the A-Test as a symptom validity measure easily administered as part of the PCE for Social Security Disability evaluations. This study shows that the A-Test is well correlated with other symptom validity measures, discriminates multiple symptom validity failure from nonmultiple failure, and has good classification accuracy statistics in two different studies of these claimants. The A-Test can thus easily be used as a symptom validity measure in professional psychological examinations of Social Security claimants without additional cost or much added time to the evaluation.

Auditory memory decrements, without dissimulation, among patients with major depressive disorder.

Questions have been raised about whether poor performance on memory tasks by individuals with major depressive disorder (MDD) might be the result of poor or variable effort or disease-related disruption of neural circuits supporting memory functions. The present study examined performance on a measure of task engagement and on an auditory memory task among 45 patients with MDD (M age = 47.82, SD = 19.55) relative to 32 healthy controls (HC; M age = 51.03, SD = 22.09). One-hundred percent of HC and MDD volunteers performed above the threshold for adequate effort on a formal measure of task engagement. The MDD subjects performed significantly more poorly than the HC subjects on an auditory learning and memory test. The present results suggest that auditory memory difficulties do occur among those with MDD and that decrements in performance in this group may be related to factors other than lack of effort.

[Recommendations for independent medical examinations of PTSD claimants]. / Empfehlungen für die Begutachtung von PTBS-Opfern.

In Germany, like in many Western countries, posttraumatic stress disorder (PTSD) is being diagnosed on an increased scale; it has become a major cost-producing factor of the healthcare and insurance industry. However, diagnosing PTSD may be problematic when it is primarily based on a symptom report. Although the forensic expert is expected to check the veracity of the symptoms reported, history taking, psychopathological assessment and diagnostic accuracy vary greatly among professionals. Thus, the diagnosis of PTSD often cannot be confirmed by later thorough inspection. Based on more than a decade of civil-forensic work in the area, the authors formulate recommendations for independent medical examinations in cases of claimed PTSD.

Propuesta del uso de la hipnosis como método diagnóstico en procedimientos forenses: A propósito de un caso con trastorno de conversión / Hypnosis as a diagnostic tool in forensic procedures. Report of a case with conversion disorder

Una vez superados los prejuicios existentes en torno a la hipnosis, de un tiempo hasta ahora se tiende a introducir de manera creciente su aplicación en el ámbito de la psicoterapia, amparado en gran medida por estudios encaminados a conocer sus bases neurofisiológicas. A raíz de un caso diagnosticado de trastorno de conversión, se propone la aplicación de la hipnosis como herramienta complementaria y eficaz de estudio pericial (AU)

After overcoming every prejudice surrounding hypnosis, a tend is emerging in order to introduce its application in psycotherapy, due to many studies published to know the neurophysiological bases of hypnosis. We present a case, affected of conversion disorder, where hypnosis was used as a complementary and effective tool for expert study into legal matters (AU)

[Babinski and hysteria]. / Babinski et l'hystérie.

Babinski made important contributions to both psychiatry and neurology. He disagreed with Charcot's theatrical interpretation of hysteria and made a subtle distinction between Suggestion and Persuasion, thereby differentiating Hysteria from Pithiatism. This paper examines Charcot's concepts and the way in which Babinski refined and honed his master's theories.

Detecting insufficient effort using the Seashore Rhythm and Speech-Sounds Perception Tests in head injury.

This study examined the capacity of the Seashore Rhythm Test (SRT) and the Speech-Sounds Perception Test (SSPT) to detect insufficient effort in a clinical sample. Forty-six participants with financially compensable mild head injury who obtained scores indicative of insufficient effort on multiple measures were compared to 49 participants with brain injury who were not involved in litigation. Receiver operating characteristic (ROC) curve analysis indicated that both the SRT (AUC = .84) and SSPT (AUC = .80) were significant (p < .001) predictors of insufficient effort. Maximizing sensitivity and specificity, the optimal cutoff scores were 8 errors on the SRT and 10 errors on the SSPT. Combining both variables into a logistic regression function increased the diagnostic efficiency.

The dissociative disorders. Rarely considered and underdiagnosed.

A wide variety of dissociative disorders, including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and various forms of dissociative disorder not otherwise specified. In many instances, these disorders are either underdiagnosed or misdiagnosed secondary to the clinician's mistaken belief that dissociative disorders are rare. Recent research shows that dissociative disorders may comprise 5% to 10% of psychiatric populations. This article reviews the epidemiology and clinical symptomatology of these disorders. In addition, various screening and diagnostic instruments, such as the DES, Structured Clinical Interview for Dissociative Disorders, and MMPI, are discussed.

Work-related, noise-induced hearing loss: evaluation including evoked potential audiometry.

This article reviews the evaluation of 246 workers (492 ears) who underwent otologic and audiologic testing as part of a worker's compensation claim for work-related, noise-induced hearing loss. Tinnitus was present in 58% of the patients, but was rarely a major symptom. Other otologic symptoms or a history of ear disease were virtually nonexistent. Standard audiometry showed a downsloping, high-frequency sensorineural hearing loss in 85% of the ears tested, with only 37% having a characteristic "noise notch" at 4000 or 6000 hertz. Asymmetric hearing loss was not uncommon, with 48 patients (20%) undergoing magnetic resonance scanning, all of whom showed no central lesion responsible for the loss. Proven malingering was surprisingly uncommon (9%). In this study, evoked response audiometry was a valuable adjunct to confirm behavioral thresholds in the evaluation of possible work-related, noise-induced hearing loss. The middle latency response was more effective than the auditory brainstem response as a result of the high-frequency steepness of the audiometric curve.

Multiple personality disorder in criminal law.

The authors review the recent literature on multiple personality disorder (MPD), the most severe and chronic of the dissociative disorders, in relation to court cases of competence to stand trial, the insanity defense, and research on malingerers feigning MPD. Issues relevant in the assessment of competency and insanity are described. Features characteristic of MPD, including amnesia and alterations in consciousness and personality, have varying degrees of influence over the criminal behavior of an individual with MPD. As in other psychiatric disorders, the influence of MPD on an individual's competence to stand trial, and sanity, can be evaluated systematically. This article discusses a specific diagnostic tool, the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), an extensively field tested instrument that is potentially quite useful in forensic assessment of suspects manifesting dissociative symptoms and disorders. The particular advantages of the SCID-D will be reviewed in the context of some well known criminal cases involving MPD. Further research using diagnostic interviews for the systematic assessment of dissociative symptoms and MPD in criminal cases will continue to clarify the influence of these symptoms in a forensic context.

Some observations on whiplash injuries.

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)

Malingering traumatic mental disorder on the Beck Depression Inventory: cancerphobia and toxic exposure.

The revised Beck Depression Inventory is widely used to measure severity of depression, and it is often used in personal injury litigation as evidence of trauma. However, the potential vulnerability of the inventory to malingering has not been assessed. Of a group of 52 untrained volunteers, 96% were able to fake depression on the inventory and 58% successfully faked extremely severe depression. Users are cautioned against treating Beck's inventory as a literal measuring instrument in contexts where manipulation of responses is a potential issue.

Malingering vs. the factitious personality in chiropractic practice.

This article details how to identify and treat the malingering patient, which we feel is seen more often than was originally thought in chiropractic practice. A historical perspective of a malingering vs. a factitious personality is examined. The factitious patient is reviewed in detail with special attention to the classic case of Munchausen syndrome. An extensive treatment plan is discussed, including short- and long-term care. The common characteristics, objective tests and studies are reviewed. We theorize that due to our increasing involvement in Workers' Compensation and personal injury cases our attention should be focused more closely on the possibility of these types of patients entering our office.

Is it organic or is it functional. Is it hysteria or malingering?

Conversion hysteria, a common affliction, requires prompt diagnosis and treatment to prevent fixation of the incapacity and secondary contractures, and to protect the patient from unnecessary surgery. Diagnostic and therapeutic principles are outlined.

Evoked potentials in hysteria and malingering.

Evoked potentials are often helpful in confirming the nonorganic nature of sensory symptoms in hysteria and malingering. In a retrospective analysis, such cases were found to comprise approximately 1% of referrals to a university hospital laboratory. However, the diagnostic usefulness of electrophysiologic tests is limited in some clinical settings: normal responses may be encountered in subjects with certain organic deficits, and "abnormal" responses can sometimes be produced voluntarily by normal subjects. In malingering--as opposed to hysteria--the role of the technologist in monitoring patient compliance with the test procedure is particularly important. Like other laboratory investigations, evoked potential findings must be interpreted within the context of each clinical situation, and with full appreciation of the sensitivities and specificities of the tests.